- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.75 / $1,450.00 / $2,373.00
| Facility | | $318.75 | $1,450.00 | $2,373.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.07 / $318.75 / $425.00
| Professional | | $237.07 | $318.75 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.00 / $1,051.00 / $2,769.54
| Facility | | $510.00 | $1,051.00 | $2,769.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.48 / $385.48 / $385.48
| Professional | | $385.48 | $385.48 | $385.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.61 / $133.62 / $178.02
| Facility | | $129.61 | $133.62 | $178.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.64 / $889.64 / $889.64
| Professional | | $889.64 | $889.64 | $889.64 |